Can lay people deliver asthma self management education as effectively as primary care-based practice nurses?

¹ Imperial College London, United Kingdom
² University of Manchester, United Kingdom
³ North West Lung Centre, Manchester, United Kingdom

^* To whom correspondence should be addressed. E-mail: m.partridge{at}imperial.ac.uk.

Accepted 31 January 2008

	Abstract

Can lay people deliver asthma self-management education as effectively as primary care-based practice nurses?

Objectives: To determine whether well-trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care-based practice nurses.

Design: Randomised equivalence trial.

Setting: Thirty nine general practices in West London and North West England.

Participants: 567 patients with asthma who were on regular maintenance therapy. Fifteen lay educators were recruited and trained to deliver asthma self-management education.

Intervention: An initial consultation of up to 45 minutes offered either by a lay educator or a practice-based primary care nurse, followed by a second shorter face-to-face consultation and telephone follow up for one year.

Main outcome measures: Unscheduled need for healthcare

Secondary outcome measures: Patient satisfaction and need for courses of oral steroids.

Results: 567 patients were randomised to care by a nurse (N=287) or a lay educator (N=280) and 146 and 171, respectively, attended the first face-to-face educational session. . During the first two consultations management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have one year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse-led group required unscheduled care, compared with 65/213 (30.5%) in the lay-led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the pre-determined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of one year. Patient satisfaction following the initial face-to-face consultation was similar in both groups.

Conclusions: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.

Keywords: Asthma, Lay Educators, Primary Care, Self Management, Unscheduled health care